Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis
Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis
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DOI：
10.1097/00007632-199710010-00008
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发表时间：
1997-10-01
期刊：
影响因子：
3
通讯作者：
Link, TM
中科院分区：
文献类型：
--
作者：
Liljenqvist, UR;Halm, HFH;Link, TM
研究设计.特发性脊柱侧凸患者胸椎椎弓根螺钉置入准确性的前瞻性研究。评价胸椎椎弓根螺钉置入在特发性脊柱侧凸手术治疗中的准确性，并确定其风险和受益。腰椎椎弓根螺钉内固定在脊柱侧凸的手术治疗中已被证明是可靠和有效的。目前还没有关于胸椎椎弓根螺钉内固定在脊柱侧凸手术中的准确性和益处的报道。对32例连续治疗的特发性脊柱侧凸患者的120枚胸椎椎弓根螺钉进行术后即刻CT扫描，并由3名检查者进行分析。30枚（25%）螺钉穿透椎弓根皮质或椎体前皮质。10枚螺钉（8.3%）穿透椎弓根内侧皮质，平均1.5 mm，最大3.0 mm。17枚螺钉（14.2%）外侧穿透，平均2.1 mm。有2例尾侧穿透。3枚螺钉穿透椎体前部皮质，其中2枚螺钉也穿透椎弓根皮质。此外，这3枚螺钉中的1枚因直接靠近胸主动脉而被更换。无神经系统并发症。椎弓根皮质穿透率与术前Cobb角、椎体旋转或水平、螺钉插入部位之间的相关性无统计学意义（P > 0.05）。在以钩为主的器械中，平均弯曲矫正率为52.5%，而以螺钉为主的器械中，平均弯曲矫正率为59.2%。差异无统计学意义（P > 0.05）。25%的螺钉发生椎弓根或椎体皮质穿透，但无神经功能损害。弯曲矫正略大于钩，但没有达到统计学显著性程度。
Study Design. A prospective study of the accuracy of thoracic pedicle screw placement in patients with idiopathic scoliosis.Objectives. To evaluate the accuracy of thoracic pedicle screw placement in the surgical management of idiopathic scoliosis and to establish its risks and benefits.Summary of Background Data. Lumbar pedicle screw instrumentation has proven to be reliable and effective in the surgical management of scoliosis. No reports exist on the accuracy and benefits of pedicle screw instrumentation of the thoracic spine in scoliosis surgery.Methods. One hundred and twenty thoracic pedicle screws in 32 consecutively treated patients with idiopathic scoliosis were investigated immediately after surgery by computed tomography scans that were analyzed by three examiners.Results. Thirty (25%) of the screws penetrated the pedicle cortex or the vertebral body anterior cortex. Ten screws (8.3%) penetrated the medial cortex of the pedicle by an average of 1.5 mm and a maximum of 3.0 mm. Seventeen screws (14.2%) penetrated laterally by an average of 2.1 mm. There were two cases of caudad penetration. Three screws penetrated the anterior vertebral cortex, of which two also penetrated the pedicle cortex. Also, one of these three screws was replaced because of its direct proximity to the thoracic aorta. There were no neurologic complications. The correlation between the pedicle cortical penetration rate and the preoperative Cobb angle, vertebral rotation or level, or site of screw insertion was statistically insignificant (P > 0.05). Curve correction in the cases of mainly hook instrumentation averaged 52.5% versus 59.2% in the cases of mainly screw instrumentation. This difference was statistically insignificant (P > 0.05).Conclusions. Pedicle or vertebral body cortical penetration occurred with 25% of the screws but with no neurologic compromise. Curve correction was slightly greater than with hooks, but not to a statistically significant extent.